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I recently returned to my office after a vacation and among all the mail and messages left for me by our office manager was a file labeled optical remakes. My office uses a special optical order form when we remake or replace eyeglasses at no charge. The form is on pink paper and has three copies so we can track the frequency and cost of remakes. Some of these optical jobs are covered under a warranty program, some are due to our own errors in prescribing, measuring or fitting, and some are due to breakage or damage of materials by our staff. Remakes are always approved by a doctor or a manager before they are ordered.
The optical remake file is nothing unusual; reviewing it from time to time is part of my normal duties. In this instance, based on the stack of pink slips, I assumed at first glance the file was for the year 2007. It turned out it was just for January! Houston, we have a problem. OK, I'm exaggerating a little bit, but the number of no charge remakes was higher than I would like, so I investigated the reason for each job.
In assessing the remake problem, I realize that my practice dispenses a high number of eyeglasses, so even with a low remake percentage; I will have a high absolute number. It's tempting for me to try to quote some percentage that might be considered normal, but it would be a disservice because the definition of the remake policy varies so much from one practice to another. It's hard to compare apples to apples in an expense category like remakes.
I also realize that my practice has a culture that places a high value on total patient satisfaction. While I strongly believe in that philosophy and it's the main reason my practice does well, that philosophy also promotes more frequent remakes. As a business person, I want to reduce remakes but not reduce the excellent customer service that often requires a remake. I want to stop what I consider unnecessary and preventable remakes.
Reasons for remakes
Let's examine some of the factors that cause an eyeglass prescription to have to be remade or reordered at no charge.
Doctor error. This happens to all of us. I don't get hung up on why a spectacle Rx is not working the way it should, I just find the problem and fix it. I don't try to shift blame to the patient or the lab or my instruments. I strongly believe in excellent customer service; it's the most important factor in practice success.
Optician error. There are lots of possibilities... incorrect measurements of PDs or seg heights are high on the list. Also, poor frame choice for a given lens Rx or poor frame fit to the patient. The error could be in the form of an omission, such as not specifying a vertical optical center measurement.
Optician damage. If we break or harm a patient's product, we replace it. We use a disclaimer form when we work on older frames, which relieves us of some extreme risk, but I know a temple can snap on a new frame also. I'll cite another example and admit that I didn't know this until recently... antireflective lenses should not be heated! We are now dispensing more plastic frames and some of my opticians place the frame front (with lenses) into the salt pan or under the hot air blower to adjust it. My lab manager advised against that because crazing or clouding can occur to the lens surface. The lenses should be removed from the frame before it's heated. One optician asked, “How can I get the lenses out without heating the frame?” It turns out the lenses should be snapped out cold, but the frame can be heated to allow easy reinsertion.
Lab error. This would not be considered a remake in my office because the job is rejected upon inspection and is returned with the original order. My definition for a no charge remake is when a new order is written, but no one paid for it.
Product defect or poor performance. This may not be anyone's fault but if a lens tint or coating does not work to the patient's satisfaction the blame often goes back to the optician or doctor with the assumption that he should have known better. A truly defective product is easy to spot and may be covered under a warranty (see that point below).
Buyer's remorse. Often disguised by the patient looking for a way out of the purchase, you may hear that some aspect of the glasses is not right when it's really the cost or the style that is the problem. It doesn't really matter. I'd let the patient save face and fix the problem. Patient satisfaction is king.
Warranty. Show me ten practices and I'll show you ten variations of eyeglass warranties. Many warranties are in place from the manufacturer or laboratory, but those are typically provided to the practice and the practice is free to decide what warranty is provided to the patient, if any. There are often different warranties for frames, lenses, antireflective materials and non-Rx sunglasses. Some practices are very lenient on warranties, some are very strict, some are given free, some are sold for a price, some are for one year, some are for life, some are no charge when used and some require a co-payment.
Of all the reasons cited above, there are two that I feel are the easiest to attack: optician error and optician damage. I would like to reduce the remakes from the other categories as well, but I feel these two are the most amenable to change.
Remakes from the warranty category result in the largest number by far in my practice and those should really be viewed separately from all the others. Warranty remakes generally have the cost covered by the supplier of the product, so while there was no charge to the patient for the order, there is no lab cost either. We should not overlook the labor cost, however. An established practice that does a great deal of warranty work will incur a significant expense in the time needed by employees to process the orders and re-deliver the products. If a warranty remake is not covered by a supplier and must be covered by the practice (such as with in-office labs), that's based on a business policy decision that the practice owner decided was in his best interest.
How to reduce remakes
It's very important to reduce the number of no charge optical orders for two major reasons: 1) the lab expense is significant and cuts into the practice net income and 2) many of the remakes are caused by errors which even if corrected create an inconvenience for the patient.
I think the best way to reduce remakes due to optician error or damage is through staff training. This should be an ongoing effort in every practice, but in reality it usually gets dropped by the wayside. I'm going to rededicate my efforts in this area and design a program of weekly staff in-service meetings. I'll write more next week on how to plan and produce staff training sessions that will improve your services and reduce your remake cost.